PRE-PROGRAM QUESTIONNAIRE

This pre-program questionnaire is for Elaine Wilkes's Presentation ______________ on __/__/___.These questions are designed to help us prepare a program specifically suited to the needs of your group. Please take a moment to answer all the questions fully and email back to Elaine@ElaineWilkes.com as soon as possible.We would also appreciate receiving any printed information on your group that may help us with background information, (e.g., corporate reports, news items, in house publications, services, employees, etc.). Thank you for your help!If you have any questions please call 310 447 8446. THE PRESENTATIONPresentation title:____________________________________________________________________________________________ Time Frame? Start time: _______________End Time:____________________Any breaks? Y N What is on the program before I speak?____________________________________________________________________________________________ Appropriate dress for the presentation?____________________________________________________________________________________________ Conference title and theme?______________________________________________

Specific purpose of this meeting/session (e.g., awards, banquet, annual meeting, etc.)______________________________________________ Specific objectives for my presentation?______________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________ Sensitive issues that should be avoided:____________________________________________________________________________________________ Introducer's name?____________________________________________________________________________________________ Introducer's Phone number: ____________________________________________________________________________________________ Who are the speakers and topics on the program?____________________________________________________________________________________________ ____________________________________________________________________________________________ What speakers have you used in the past that covered topics related to the material I will be presenting?____________________________________________________________________________________________ ____________________________________________________________________________________________ What did you like and/or dislike? Withhold their names if you like, but do comment on the material they used.____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ What comments or suggestions do you have that will help me make this presentation the best your audience has ever had?____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ THE AUDIENCETotal attending?__ _________Spouses or children attending?_________Percentage male/female?__ ________Average age? __________

Will there be any special guests?______________Why is your group attending this meeting (Voluntary mandatory, etc.)?____________________________________________________________________________________________ ____________________________________________________________________________________________ How will they be notified?____________________________________________________________________________________________ ____________________________________________________________________________________________ DETAILS ABOUT YOUR AUDIENCEProblems?____________________________________________________________________________________________ Challenges?____________________________________________________________________________________________ Breakthroughs?____________________________________________________________________________________________

Phone____________________________________________________________________________________________ Location at the site (room name, etc.) ____________________________________________________________________________________________ Airport to arrive at____________________________________________________________________________________________How will I be transported front he airport to your site?Taxi? __________ Rental Car? __________ Driver? __________Driver's Name__________Phone __________If an emergency occurs ont he way to the site, who would be tan alternative contact if you're unavailable?Name and Phone:____________________________________________________________________________________________ Thank you for taking the time to provide this information. I will use it to prepare an outstanding presentation for your group.

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